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V9

RISK ASSESSMENT
ACTIVITY

HAZARD

RISK
H/M/L

Choking on mint
Strobe light making it hard
to see

Please leave this section blank:


Risk Assessment checked by: Name ..
KEY:

Activity :
Hazard :
Risk:
Precautions:
In Place:
Review Date:
Reviewer:

V9/PALL/sspi/reviewedOct2010

PRECAUTIONS

IN
PLACE

REVIEW
DATE

Dont swallow

Yes

10/12/15

Make sure everyones aware of the


surroundings

Yes

10/12/15

Signed .

REVIEWER

Matthew
Brienza
Matthew
Brienza

Date

Describe the component part of your pursuit.


List the things you anticipate might cause harm or the things associated with your activity that have the potential to cause harm. Consider the likely
harm.
Assess the risk as either H (High), M (Medium) or L (Low). When concluding your assessment consider all of the circumstances.
Consider what you could do to minimise / negate the risk.
Will the precautionary measures be in place at the time of the activity?
When would it be reasonable to review your assessment? Remember it might be whilst you are undertaking the activity.
Name of the person responsible for completing the risk assessment.
A copy of this form should be taken on the activity or visit by the Reviewer.